Individual
LIDESYAN LINCOLN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E 15TH ST STE 117, FORT WORTH, TX 76102-6522
(940) 280-2621
Mailing address
100 E 15TH ST STE 117, FORT WORTH, TX 76102-6522
(940) 280-2621
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
116245
TX
Other
Enumeration date
11/22/2024
Last updated
11/22/2024
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